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may be possible to induce antibody levels higher thanthose found after natural infection. Whether such

antibodies will protect and persist remains to be seen.H strains are commoner causes of colds than M strains,

and possibly when H strains are used as antigens theresults reported here will not be repeated and the hopesraised by the experiments may be dashed. TAYLOR-ROBINSON 13 has evidence that antibody levels foundafter natural infection with H strains are lower anddecline more rapidly than those induced by M strains.KETLER et al.14 have studied the antibody responses tonatural infection with 10 different serotypes of H strainrhinoviruses (coryzaviruses in their nomenclature) andare impressed by the specific character of the antibodyresponse; but the antibody titres they record are low andheterotypic responses might have been missed. Never-theless the Salisbury workers did show that an M viruspropagated in human diploid-cell strains was antigenic,which indicates that it might be practicable to makeH-strain vaccines in these cells-these viruses have notbeen adapted to monkey-kidney cells.The parainfluenza viruses and respiratory syncytial

virus cause colds in children and adults and also moresevere illnesses in children. They are widely distributedin all populations so far studied. In the U.S.A. largetrials are to be undertaken with the object of preventingthe severe illnesses in children by vaccinating themagainst these viruses. 15 Circulating antibodies are

generally believed not to prevent infection or the mildsort of illness produced by these agents. Cattle sufferfrom infections with parainfluenza-3 virus, and levels ofantibody which are higher than those found in randomlyselected animals have been induced by vaccination withan oil-adjuvant parainfluenza-3 vaccine.15 If this couldbe done in man the incidence of mild disease-i.e.,common colds-due to this virus might be reduced.Whether rhinoviruses can cause more severe illnesses inthe way the parainfluenza viruses do is at present notclear. REILLY et al.16 recovered such viruses from a fewchildren with bronchitis, pneumonia, and laryngitis; andit may reasonably be supposed, though it is unproven,that the disease was due to the virus isolated. On theother hand in a study among adults in which they foundthat rhinoviruses (in their nomenclature enterovirus-likeviruses) caused afebrile colds, JOHNSON et a1.17 foundlittle evidence that these organisms caused anything sosevere as a febrile cold. If it should turn out that arhinovirus can occasionally cause disease of the lowerrespiratory tract, then a vaccine against it might preventthis sort of illness besides common colds. There willbe many months-even years-of incubation before wecan expect to find any of these eggs hatching, anduntil then we must follow the usual advice about countingchickens.13. Taylor-Robinson, D. Arch. ges. Virusforsch. (in the press).14. Ketler, A., Hamparian, V. V., Hilleman, M. R. Proc. Soc. exp. Biol.,

N.Y. 1962, 110, 821.15. Proceedings of the Conference on Newer Respiratory Virus Diseases,

Bethesda, Md, U.S.A., October, 1962 (in the press).16. Reilly, C. M., Hoch, S. M., Stokes, J., Jr., McClelland, L., Hamparian,V. V., Ketler, A., Hilleman, M. R. Ann. intern. Med. 1962, 57, 515.17. Johnson, K. M., Bloom, H. H., Chanock, R. M., Mufson, M. A.,Knight, V. Amer. J. publ. Hlth, 1962, 52, 933.

Russian Thaw

COMMUNIST theoreticians are very much alive to the

sociological implications ofPAVLOV’s theories, and underSTALIN the work of this humane and broadminded manbecame a focus of intellectual repression. Lip-service toPAVLOV became obligatory: opposition to his theories,or attempts to modify them in the light of new results,might face the author with a choice between the loss ofhis livelihood and an abject recantation such as thefollowing: " I consider that the principal cause of myerrors has been the ignorance of the work of 1. P. Pavlovwhich until recently typified my point of view. I can

only attribute my failure to understand his theories tothe fact that I have for too long been influenced by thebourgeois psychiatry of the West."Xenophobia was probably only one of the motives

underlying this attempt to enforce conformist thinking;H. G. WELLS may have hit on another when he pointedout that stereotypy of thinking, of art, and of moralcriteria is characteristic of peasant cultures such as thatfrom which modern Russia is emerging. Fear of changeis, of course, a feature of youth as well as of old age, anda good deal of the harshness so often seen with newregimes derives from a feeling of insecurity, which maylast for decades. Whatever the cause, it is beyond doubtthat, under STALIN at least, a strong effort was made tochannel in advance the directions which neurophysio-logical-and psychological-thought might safely take;at all costs any " distortion " of Pavlovian theory was tobe resisted, with just that doctrinal fervour which, ifdevoted to the Scriptures, would have been considereda crime. Thus in 1951 it was announced that " theCommune have defined the factors impeding the

application of the scientific heritage of the great physio-logist and have traced the path along which his inspiredideas will best be able to develop ...". Meanwhile, byone of those ironies which make life so fickle and poetical,a highly fertile development was indeed taking place-but in America.

Whereas PAVLOV held that the individual’s behavioural

repertoire is built up entirely by the conditioned associa-tion of fresh stimulus-situations to a fixed set of innate

responses, B. F. SKINNER’S notion of operant condition-ing implies that the set of available responses is also (atleast in youth) being continually enriched-since certainpatterns of action, originating more or less by chance,become perpetuated to the extent that they bring someform of reward. One can see how such an idea strikes atthe concept of predetermined intellectual advance: it

suggests that new ideas and new patterns of behaviourwill continually well up in a society, as if by mutation;and that the stability of society depends on the main-tenance of a system capable of gradual evolution ratherthan of a fixed social status quo. The need is for a social

" steady-state " equilibrium rather than a static one.The paralysing effects of the Stalinist " freeze " on

medical, neurophysiological, and psychological circleswere well described by Dr. LAZAREVITCH in a book fullydocumented with references to Russian official literature.

1. Lazarévitch, I. La Médecine en U.R.S.S. Paris, 1953.

258

In 1956-58, however, a vigorous effort was made to

sweep away some of the worst features of the Stalin era;and the reality of the

" thaw ", as regards the Pavlovissue, is attested by the reinstatement of some of thedissenters who were swept from favour at the height ofthe Pavlov cult. On the other hand, in some otherspheres, recent attempts at melting official frigor haveresulted in a cautious withdrawal into the old puritanorthodoxy. Whether the thaw will gradually becomegeneral is therefore uncertain: as so often, it has beenaccompanied by a fair amount of chilly fog.

Annotations

PLANNING OF UROLOGICAL DEPARTMENTS

To meet the needs alike of patients, urological surgeons, ’

and administrators, the establishment of a nation-wideurology service is needed; official recognition of this

subject as a specialty is long overdue. At present theclinics which specialise exclusively in genitourinarysurgery are too few to give an adequate service. Thesefacts emerged from a meeting, on Jan. 24, of the Sectionof Urology of the Royal Society of Medicine, at which theplanning and organisation of urological departments werediscussed.

In principle, urological units should be integral partsof large general hospitals rather than isolated clinics, butspeakers agreed that where possible such units should haveindependent ward and nursing administration, operating-theatres, laboratory services, and sterile supplies. There wasless agreement over the organisation of radiological services:a urological department needs so much special equipmentand so many special techniques that it should perhapshave apparatus on the spot. It was suggested that

diagnostic facilities provided for urology could be sharedby other specialties with somewhat similar requirements.In a diagnostic section a generous number of recoverybeds for day patients is essential, the usual preferencebeing to use general rather than local anaesthesia for

endoscopic examination. With modern general anxstheticsthe patient recovers so rapidly that only very simplearrangements are necessary, and the nursing care need notbe elaborate. One of the peculiar needs of a urologicalservice is an abundant supply of sterile water, and therewas some debate on how this could best be ensured. No

general agreement was reached: bottling of sterile water,although most reliable, is difficult in the quantitiesneeded. Several speakers mentioned the need for researchfacilities in new units, although it is perhaps debatablewhether these should be considered as part of a clinicalservice or should have special accommodation.The present rapid progress in renal vascular surgery

and in renal homotransplantation must greatly influencethe planning of new departments of urology.

MERCURY AND THE KIDNEY

THE clinical spectrum produced by mercury poisoningranges through erethism, stomatitis, sialorrhoea, tremor,and skin rashes to albuminuria and the nephrotic syn-drome. More bizarre symptoms such as dysphonia,dysarthria, ataxia, and severe constriction of the visualfields have also been described. Isolated cases still arise,underlining the importance of taking an occupationalhistory.! Mercury may still be a hazard in physiological

and medical laboratories if precautions are not observed 2;and Kazantzis et al. have re-examined the industrial

aspects of the problem.The interest of Kazantzis et al. was aroused by the

finding of three cases of the nephrotic syndrome, and ofa further case which is perhaps best described as theprenephrotic syndrome. All these patients were engagedin occupations which brought them into close proximitywith mercury. The diagnosis was established in the

nephrotic cases by the presence of severe oedema, massivealbuminuria, hypoalbuminsemia, and hypercholestero-laemia. The evidence for a prenephrotic state in the fourthcase consisted of moderate albuminuria, a serum-

cholesterol of 357 mg. per 100 ml., and a urinary proteinelectrophoretic pattern consistent with that of type-2nephritis. All thes.e patients were excreting over 1000 ug.of mercury per litre of urine when they were first seen,even though this was some time after their last exposure.300 ug. per litre of urine is taken by some workers 4 asthe critical level above which symptoms may arise.Screening of the workers at the two factories where thefour patients worked confirmed the lack of correlationbetween urinary levels and clinical status. In view ofthis, Kazantzis et al. suggest that the association of thenephrotic syndrome with mercury is due to an idiosyn-

crasy to the metal, even though histochemical examina-tion of renal biopsy specimens obtained from two of thecases showed a massive concentration of the metal com-pared with the normal. They argue that the damage tothe proximal convoluted tubule demonstrated by histolo-gical examination, with suppression of alkaline phosphataseand succinic dehydrogenase activity in this region, maybe related to the direct effect of mercury intoxication butthat the tubular damage alone is not sufficient to accountfor the onset of nephrosis. But the glomeruli in the renalbiopsy specimens do not appear to have been examinedby electron microscopy; hence it is doubtful whether thisconclusion can be substantiated. Furthermore, it is a littledifficult to understand why in the cases obtained in thesurvey the lesions were virtually all renal. Slit-lampmicroscopy of all the workers at risk, including the fourcases described in detail, might have demonstrated thecharacteristic changes of mercurialentis. This physicalsign seems to be of great value in the early detection ofchronic mercury poisoning, which probably does notoccur in its absence.5

The fact that blood and urine levels of mercury can

rarely be correlated 6 is a further difficulty. Kazantziset al. seem to imply that the best treatment for renallesions acquired by contact with mercury is simplyremoval from the source of exposure. It is difficult toknow on what evidence they base this statement: thethree cases of the nephrotic syndrome they describe wereall treated with a veritable battery of remedies, includingsteroids, diuretics, and salt-free high-protein diets.Nevertheless terminating exposure to the metal maysuffice provided the nephrosis has not entered an irre-versible phase. Modern chelating agents 1 seem to becontraindicated since their administration might subjectthe kidneys to greater concentration -of the metal over ashort period, thereby aggravating the renal disorder.1. Smith, A. D. M., Miller, J. W. Lancet, 1961, i, 640.2. Noe, F. E. New Engl. J. Med. 1959, 20, 1002.3. Kazantzis, G., Schiller, K. F. R., Asscher, A. W., Drew, R. G. Quart. J.

Med. 1962, 31, 403.4. Lane, R. E. Brit. med. J. 1954, i, 978.5. Locket, S., Nazroo, I. A. Lancet, 1952, i, 528.6. Goldwater, L. J., Jacobs, M. B., Ladd, A. C. Arch. environm. Hlth,

1962, 5, 537.